Neurological Populations Research Articles

Prerequisites and barriers to telerehabilitation in patients with neurological conditions: A narrative review.

A field of study that uses telerehabilitation (TR) is neurorehabilitation; however, standards for medical and technological applications, medicolegal and ethical regulations, and other aspects of neuro-TR are still being developed. To address the prerequisites and barriers for implementing TR in neurorehabilitation in the light of present findings. A narrative review was conducted based on specific questions about the prerequisites for neuro-TR and barriers to its implication. According to a foreground search strategy in the context of neurorehabilitation using TR in neurological patient population, PubMed, EMBASE and Cochrane databases were searched and reviewed. Barriers and prerequisites for neuro-TR were mostly grouped under the categories of administrative/organizational, human (beneficiaries/providers), technical, and ethical. Apart from the technical framework, knowledge and the presence of an administrative leader responsible for overseeing TR are crucial prerequisites. The internet and technological constraints rank highest among the barriers. Since neuro-TR is relatively new with minimal guidelines and regulations, highly technologic, and lack of established practices, it is imperative to determine and fully comprehend the criteria for its uses. After the prerequisites are established, it is imperative to recognize and address implementation constraints, which may differ depending on the community's infrastructure and neurologic condition.

Talar and Calcaneal Coordinate Axes Definitions across Foot Pathologies

The understanding of foot and ankle biomechanics is improving as new technology provides more detailed information about the motion of foot and ankle bones with biplane fluoroscopy, as well as the ability to analyze the hindfoot under weightbearing conditions with weightbearing computed tomography. Three-dimensional anatomical coordinate systems are necessary to describe the 3D alignment and kinematics of the foot and ankle. The lack of standard coordinate systems across research study sites can significantly alter experimental data analyses used for pre-surgical evaluation and post-operative outcome assessments. Clinical treatment paradigms are changing based on the expanding knowledge of complex pes planovalgus morphologies or progressive collapsing foot deformity, which is present in both neurologic and non-neurologic populations. Four patient cohorts were created from 10 flexible PCFD, 10 rigid PCFD, 10 adult cerebral palsy, and 10 asymptomatic control patients. Six coordinate systems were tested on both the talus and calcaneus for all groups. The aim of this study was to evaluate axes definitions for the subtalar joint across four different patient populations to determine the influence of morphology on the implementation of previously defined coordinate systems. Different morphologic presentations from various pathologies have a substantial impact on coordinate system definitions, given that numerous axes definitions are defined through geometric fits or manual landmark selection. Automated coordinate systems that align with clinically relevant anatomic planes are preferred. Principal component axes are automatic, but do not align with clinically relevant planes and should not be used for such analysis where anatomic planes are critical.

I didn’t know I had executive dysfunction, now I can do something about it: perspectives about CO-OP from people with Parkinson’s disease

Purposes People with Parkinson’s disease (PD) experience increasing disability across their lifespan. Holistic rehabilitation approaches are needed to maximize their daily functioning and quality of life (QoL). The Cognitive Orientation to daily Occupational Performance (CO-OP) approach targets daily functioning, with established efficacy in other neurological populations. This study is part of a larger trial of CO-OP with people with PD, describing the perspectives of people with PD who received CO-OP about its effect on their lives. Methods People with PD participating in a randomized controlled trial (RCT) were interviewed following the CO-OP programme. Views about the feasibility, acceptability, and experiences of CO-OP were explored. Inductive thematic analysis was used to interpret the findings. Results Analysis of interviews (n = 20) identified that CO-OP drove positive change in participants’ daily lives. Participants reported transfer and generalization of learned strategies, suggesting effective use of skills learned in CO-OP. Conclusions Addressing a critical gap in PD management, findings suggest that CO-OP was perceived as effective in addressing a broad scope of PD-related issues. Findings hold particular significance for individuals experiencing long-term PD consequences, potentially offering a viable option to enhance participation and QoL. Findings support CO-OP as an implementable, acceptable, and potentially beneficial intervention in PD. Further research is warranted to establish efficacy.

What attributes of digital devices are important to clinicians in rehabilitation? A cross-cultural best-worst scaling study

BackgroundDigital interventions are becoming increasingly popular in rehabilitation. Understanding of device features which impact clinician adoption and satisfaction is limited. Research in the field should be conducted across diverse settings to ensure digital interventions do not exacerbate healthcare inequities. ObjectiveThis study aimed to understand rehabilitation clinicians’ preferences regarding device attributes and included a cross-cultural comparison. Materials and MethodsChoice experiment methodology (best-worst scaling) was used to survey rehabilitation clinicians across Australia and Brazil. Participants completed 10 best-worst questions, choosing the most and least important device attributes from subsets of 31 attributes in a partially balanced block design. Results were analysed using multinomial models by country and latent class. Attribute preference scores (PS) were scaled to 0–100 (least to most important). ResultsA total of 122 clinicians from Brazil and 104 clinicians from Australia completed the survey. Most respondents were physiotherapists (83%) working with neurological populations (51%) in the private/self-employed sector (51%) who had experience using rehabilitation devices (87%). Despite preference heterogeneity across country and work sector (public/not-for-profit versus private/self-employed/other), clinicians consistently prioritised patient outcomes (PS 100.0, 95%CI: 86.2–100.0), patient engagement (PS 93.9, 95%CI: 80.6–94.2), usability (PS 81.3, 95%CI: 68.8–82.5), research evidence (PS 80.4, 95%CI: 68.1–81.7) and risk (PS 75.7, 95%CI: 63.8–77.3). In Australia, clinicians favoured device attributes which facilitate increased therapy dosage (PS 79.2, 95%CI: 62.6–81.1) and encourage patient independent practice (PS 66.8, 95%CI: 52.0–69.2). In Brazil, clinicians preferred attributes enabling device use for providing clinical data (PS 67.6, 95%CI: 51.8–70.9) and conducting clinical assessments (PS 65.6, 95%CI: 50.2–68.8). ConclusionClinicians prioritise patients’ needs and practical application over technical aspects of digital rehabilitation devices. Contextual factors shape clinician preferences rather than individual clinician characteristics. Future device design and research should consider preferences and influences, involving diverse stakeholders to account for context-driven variations across cultures and healthcare settings.

Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review.

This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment. Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley's methodological framework was adapted for this scoping review. Two reviewers screened the abstracts and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated. Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge. Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists. The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.

Noninvasive analysis of overactive muscle structure and elasticity after botulinum toxin type A injection: a systematic review and meta-analysis.

Injections of botulinum toxin type A (BoNT-A) are the first-line treatment for spastic muscle overactivity (MO). Some authors observed that BoNT-A injections lead to changes in muscle structure and muscle elasticity that are probably not completely reversible. This possible effect is critical, as it could lead to negative impacts on the effectiveness of BoNT-A interventions. Our study aimed to evaluate the current literature regarding changes in muscle elasticity and structure after BoNT-A injection, by diagnostic imaging, in neurological populations with MO. Our second objective was to pool all articles published on this topic in order to provide a quantitative synthesis of the data. A systematic search was conducted between October 2021 and April 2023 using different databases in accordance with PRISMA guidelines. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the studies. A meta-analysis was performed to compare muscle elasticity and structure before and after BoNT-A injections. A sample of 34 studies was selected for qualitative review and 19 studies for quantitative review. Meta-analysis of pre-post studies demonstrated significant improvement with a medium effect size (standardized mean difference=0.74; 95% CI 0.46-1.02; P<0.001) of muscle elasticity assessed by ultrasound elastography (USE) 4 weeks after BoNT-A injection. No statistically significant difference was found for muscle thickness, pennation angle, and muscle echo-intensity assessed by magnetic resonance imaging and/or ultrasonography at short-term. On the other hand, normalized muscle volume decreased with a small effect size (standardized mean difference = -0.17; 95% CI -0.25 - -0.09; P<0.001) 6 months after BoNT-A injection. Muscle elasticity measured by USE improves with a temporary effect at short-term following BoNT-A injections. Synthesis of studies that assesses muscle structure is hindered by methodological differences between studies. However, based on a small amount of data, normalized muscle volume seems to decrease at long-term after BoNT-A injections in children with CP suggesting that the timing of re-injection should be considered with caution in this population. Further work should focus on the long-term effect of repeated injections on muscle structure and elasticity in neurological populations.

Families as partners in neonatal neuro-critical care programs.

Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.

Identifying Systems Developed for Classifying Physiotherapy Interventions in Neurological Rehabilitation: A Scoping Review

Purpose: The purpose of the study was to conduct a scoping review of classification systems developed for physiotherapy interventions of persons with neurological conditions, describing the information captured, organizational structure, and methods used in development. Methods: Five electronic databases and grey literature were searched, three journals were hand searched, and all articles identified in electronic databases were forward searched. All article types except conference proceedings were considered. Articles were included if they were in English and described: a classification system developed to capture physiotherapy interventions, the contents of the classification system, and its use with neurological patient populations. Results: Twenty unique classification systems were identified that differed greatly in the amount of intervention detail described and in how they were developed and structured. Conclusion: There is significant heterogeneity in the amount of detail and structure between the classification systems. There is a need for continued work to develop a system or refine an existing system. A system should describe therapy activities in sufficient detail for communication and evaluative purposes, while considering the feasibility and acceptability across various contexts to ensure successful implementation.

Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator.

Higher levels of resilience is associated with improved pain outcomes in chronic pain and other neurological populations, but the role of resilience in pain following spinal cord injury (SCI) remains unclear. This study examined resilience as a moderator in the relationship between perceived stress and both pain intensity and interference during acute rehabilitation for SCI. Individuals admitted to inpatient rehabilitation acutely following SCI (N = 57) completed measures of perceived stress, resilience, pain intensity, and interference. The Johnson-Neyman procedure was used to examine significance of conditional relationships that emerged. Resilience was found to moderate the relationship between perceived stress and pain interference, but not pain intensity, during inpatient rehabilitation. When resilience is low, perceived stress has a more profound and adverse impact on pain interference during inpatient rehabilitation, suggesting therapeutic strategies that build components of resilience are needed during acute rehabilitation following SCI. The relationship between stress, resilience, and pain may differ postinpatient rehabilitation for SCI and warrants further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence of Obstructive Sleep Apnea and Insomnia in Neurological Populations (P9-9.006)

Prevalence of Obstructive Sleep Apnea and Insomnia in Neurological Populations (P9-9.006)

Development and evaluation of a BCI-neurofeedback system with real-time EEG detection and electrical stimulation assistance during motor attempt for neurorehabilitation of children with cerebral palsy.

In the realm of motor rehabilitation, Brain-Computer Interface Neurofeedback Training (BCI-NFT) emerges as a promising strategy. This aims to utilize an individual's brain activity to stimulate or assist movement, thereby strengthening sensorimotor pathways and promoting motor recovery. Employing various methodologies, BCI-NFT has been shown to be effective for enhancing motor function primarily of the upper limb in stroke, with very few studies reported in cerebral palsy (CP). Our main objective was to develop an electroencephalography (EEG)-based BCI-NFT system, employing an associative learning paradigm, to improve selective control of ankle dorsiflexion in CP and potentially other neurological populations. First, in a cohort of eight healthy volunteers, we successfully implemented a BCI-NFT system based on detection of slow movement-related cortical potentials (MRCP) from EEG generated by attempted dorsiflexion to simultaneously activate Neuromuscular Electrical Stimulation which assisted movement and served to enhance sensory feedback to the sensorimotor cortex. Participants also viewed a computer display that provided real-time visual feedback of ankle range of motion with an individualized target region displayed to encourage maximal effort. After evaluating several potential strategies, we employed a Long short-term memory (LSTM) neural network, a deep learning algorithm, to detect the motor intent prior to movement onset. We then evaluated the system in a 10-session ankle dorsiflexion training protocol on a child with CP. By employing transfer learning across sessions, we could significantly reduce the number of calibration trials from 50 to 20 without compromising detection accuracy, which was 80.8% on average. The participant was able to complete the required calibration trials and the 100 training trials per session for all 10 sessions and post-training demonstrated increased ankle dorsiflexion velocity, walking speed and step length. Based on exceptional system performance, feasibility and preliminary effectiveness in a child with CP, we are now pursuing a clinical trial in a larger cohort of children with CP.

Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies.

Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.

Brief High-Velocity Motor Skill Training Increases Step Frequency and Improves Length/Frequency Coordination in Slow Walkers With Chronic Motor-Incomplete Spinal Cord Injury

ObjectiveTo quantify spatiotemporal coordination during overground walking among persons with motor-incomplete spinal cord injury (PwMISCI) by calculating the step length (SL)/step frequency (SF) ratio (ie, the Walk Ratio [WR]) and to examine the effects of motor skill training (MST) on the relationship between changes in these parameters and walking speed (WS). DesignBetween-day exploratory analysis. SettingResearch laboratory in a rehabilitation hospital ParticipantsPwMISCI (N=26). Interventions3-day high-velocity MST. Main Outcome MeasuresOverground WS, SL, SF, and WR measured during the 10-Meter Walk Test. ResultsAmong the full sample, MST was associated with increases in WS, SL, SF, and a decrease in the WR. Relative change in WS and SF was higher among slow (ΔWS=↑46%, ΔSF=↑28%) vs fast (ΔWS=↑16%, ΔSF=↑8%) walkers. Change in the WR differed between groups (slow: ΔWR=↓10%; fast: ΔWR=0%). Twenty-six percent of the variability observed in ΔWR among slow walkers could be explained by ΔSF, while ΔSL did not contribute to ΔWR. Among fast walkers, ΔSL accounted for more than twice the observed ΔWR (43%) compared to ΔSF (15%). ConclusionsOn the whole, WR values among PwMISCI are higher than previous reports in other neurologic populations; however, values among fast walkers were comparable to noninjured adults. Slow walkers demonstrated greater variability in the WR, with higher values associated with slower WS. Following MST, increases in WS coincided with a decrease in the WR among slow walkers, mediated primarily through an effect on SF. This finding may point to a specific mechanism by which MST facilitates improvements in WS among PwMISCI with greater mobility deficits.

Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective.

The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.

A Mixed Method Study: Exploring Occupational Therapy Practitioners’ Experiences and Perceptions of Virtual Care for Neurological Conditions

Objective: This study comprehensively investigates the experiences and perceptions of occupational therapy practitioners (OTPs) regarding virtual care for neurological conditions, with a particular focus on patient-centered practice and interprofessional collaboration. Methods: A mixed-methods survey involving 170 OTPs specializing in neurological conditions was conducted to gather data. Quantitative data were analyzed to calculate percentages and statistics, while qualitative data were subjected to thematic analysis to gain insights into the practitioners’ perspectives. Results: The study found that 72% of OTPs expressed comfort with performing virtual assessments, and 70% felt comfortable with virtual treatments. However, there were variations in comfort levels, particularly concerning assessments in the adult neurological population, with only 20% feeling comfortable in this context. Video conferencing was the most widely adopted virtual care platform (65%), followed by electronic health records (48%) and mobile apps (30%). The survey revealed that OTPs provided a range of services virtually, including psychosocial support (62%) therapeutic exercise and activities (78%), and patient/ caregiver education (60%). OTPs working with pediatric populations reported a higher perceived value in telehealth services (76%) compared to those working with adult populations (61%). Key facilitators to promote usage of telehealth with neurological conditions included telehealth-specific training programs, digital assessment tools, interprofessional collaboration, and patient engagement strategies. Barriers included training gaps, especially in adult neurological assessments. Conclusion: This study highlights the evolving role of occupational therapy in the realm of virtual care for neurological conditions. While the majority of practitioners recognize the importance of virtual care, tailored training and support programs are needed to address variations in comfort levels, particularly in assessments for adult neurological patients. Interprofessional collaboration is crucial for enhancing patient care. The study provides valuable insights for practitioners, educators, and healthcare institutions to optimize virtual care in the digital age.

Exploring the use of bimodal transcranial direct current stimulation to enhance movement in individuals with patellofemoral pain-A sham-controlled double blinded pilot study.

In individuals with patellofemoral pain (PFP), addressing increased knee valgus during weight-bearing activities typically involves strengthening weak hip muscles. However, recent literature highlights the role of altered descending central control in abnormal movements associated with PFP. While transcranial direct current stimulation (tDCS) has demonstrated the capacity to enhance neuroplasticity, its application targeting the corticomotor function of gluteal muscles in PFP remains unexplored. This study aimed to investigate the effects of combining bimodal tDCS with exercise on frontal plane kinematics in individuals with PFP. The hypothesis was that bimodal tDCS, specifically targeting the corticomotor function of the gluteal muscles, would augment the effectiveness of exercise interventions in improving frontal plane kinematics compared to sham stimulation. Ten participants with PFP participated in two sessions involving either bimodal tDCS or sham stimulation, concurrently with hip strengthening exercises. Weight-bearing tasks, including single leg squat, single leg landing, single leg hopping, forward step-down, and lateral step-down, were performed and recorded before and after each session. Pain visual analog scale (VAS) scores were also documented. A one-way ANOVA with repeated measures was employed to compare kinematics, while a Friedman test was used to compare VAS across the three conditions (pre-test, post-tDCS, and post-Sham). We observed no significant differences in trunk lean angle, hip and knee frontal plane projection angles, or dynamic valgus index among the three conditions during the five weight-bearing tasks. VAS scores did not differ across the three conditions. A single session of tDCS did not demonstrate immediate efficacy in enhancing frontal plane kinematics or relieving pain in individuals with PFP. Considering observed positive outcomes in other neurological and orthopedic populations with multi-session tDCS applications, suggesting potential cumulative effects, further research is essential to explore the effects of multi-session tDCS on weight-bearing movement and underlying neurophysiology in individuals with PFP.

The evolution of augmented reality to augment physical therapy: A scoping review

Augmented reality is increasingly used in health care, yet little is known about how AR is being used in physical therapy practice and what clinical outcomes could occur with technology use. In this scoping review, a broad literature review was conducted to gain an understanding of current knowledge of AR use and outcomes in physical therapy practice. A structured literature search of articles published between 2000 to September 2023 that examined the use of AR in a physical therapy context was conducted. Reference lists of articles for full review were searched for additional studies. Data from articles meeting inclusion criteria were extracted and synthesized across studies. 549 articles were identified; 40 articles met criteria for full review. Gait and balance of neurological and older adult populations were most frequently targeted, with more recent studies including orthopedic and other populations. Approximately half were pilot or observational studies and half are experimental. Many studies found within group improvements. Of studies reporting between group differences, AR interventions were more effective in improving function almost half of the time, with 20%, 27% and 28% showing efficacy in disability, balance, and gait outcomes. AR in physical therapy holds promise; however, efficacy outcomes are unclear.

Daily Emotional Experiences in Persons with Parkinson Disease: Relations to Subjective Cognitive Complaints and Quality of Life

Aim This study aims to explore positive and negative emotional experiences during the performance of daily occupations in Persons with Parkinson Disease (PwPD). Methods This cross-sectional study included 32 PwPD and 14 healthy older adults. Participants completed three questionnaires that measured emotional experiences during daily occupations, subjective cognitive complaints, and quality of life. Results PwPD experienced higher rates of negative affect during all occupations. Lower rates of positive affect were found only during personal care tasks. Additionally, experiences of daily negative affect were positively associated with subjective cognitive complaints and negatively associated with quality of life. Conclusion Different rates of positive and negative affect are experienced by PwPD during daily occupations. The experience of daily emotions has implications for understanding emotional processing in neurological populations. Occupational therapy practitioners should consider the role of emotions when providing occupation-based interventions for PwPD.

Using the axonal protein neurofilament light to distinguish psychiatric and neurodegenerative disorders across a program of clinical research studies

Introduction:There is an urgent need for clinical blood biomarkers which can rule in/out neurological disorders early in those with psychiatric symptoms, personality or behavioural changes and/or functional decline together with cognitive symptoms. The neuronal axonal protein neurofilament light (NfL) is released from damaged neuronal axons and can be measured in in blood and cerebrospinal fluid (CSF). We have undertaken a series of studies aimed at examining the clinical utility of blood and CSF NfL in assisting with the distinction between psychiatric and neurodegenerative / neurological disorders.Methods:Since 2016 we have measured blood and CSF NfL levels across multiple psychiatric and neurological populations recruited through Neuropsychiatry, Royal Melbourne Hospital and our collaborators (national and international). We have described our findings in a series of published studies. Data from our ongoing work, in larger cohorts and diagnostic groups, will be presented. The diagnostic groups include people with psychiatric disorders (schizophrenia, bipolar disorder, depression, functional neurological disorders), neurodegenerative disorders (Alzheimer’s disease, frontotemporal dementia, Huntington’s disease, Niemann-Pick Type C) and neurological disorders (e.g., epilepsy).Results:Our initial pilot study (n=129) found that CSF NfL was a promising biomarker in differentiating psychiatric from neurological disorders. In our larger follow up larger study (n=498) which included more diagnostic groups CSF NfL levels exhibited high accuracy (91%), sensitivity (92%), and specificity (87%) in differentiating psychiatric from neurological disorders, and distinguished behavioural variant frontotemporal dementia from frontal lobe syndrome phenocopies/mimics, with high accuracy. We have found that NfL is not elevated in people with treatment resistant schizophrenia compared to controls and is elevated in people with Niemann-Pick Type C compared to people with psychiatric disorders and controls. Further (unpublished) data has shown that these findings are replicated with plasma NfL levels across 400 further psychiatric, neurological and control participants.Conclusions:NfL is a highly promising biomarker which differentiates psychiatric from neurological disorders with high sensitivity and specificity. The translation of NfL levels into standard clinical practice could substantially improve the clinical diagnostic process in people with complex neuropsychiatric and cognitive disorders.

Auditory attention measured by EEG in neurological populations: systematic review of literature and meta-analysis

Sensorimotor synchronization strategies have been frequently used for gait rehabilitation in different neurological populations. Despite these positive effects on gait, attentional processes required to dynamically attend to the auditory stimuli needs elaboration. Here, we investigate auditory attention in neurological populations compared to healthy controls quantified by EEG recordings. Literature was systematically searched in databases PubMed and Web of Science. Inclusion criteria were investigation of auditory attention quantified by EEG recordings in neurological populations in cross-sectional studies. In total, 35 studies were included, including participants with Parkinson’s disease (PD), stroke, Traumatic Brain Injury (TBI), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS). A meta-analysis was performed on P3 amplitude and latency separately to look at the differences between neurological populations and healthy controls in terms of P3 amplitude and latency. Overall, neurological populations showed impairments in auditory processing in terms of magnitude and delay compared to healthy controls. Consideration of individual auditory processes and thereafter selecting and/or designing the auditory structure during sensorimotor synchronization paradigms in neurological physical rehabilitation is recommended.